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Norman AV, Smolkin ME, Farivar BS, Tracci MC, Weaver ML, Kern JA, Ratcliffe SJ, Clouse WD. Current Transthoracic Supra-Aortic Trunk Surgical Reconstruction Has Similar 30-Day Cardiovascular Outcomes Compared to Extra-Anatomic Revascularization but With Higher Morbidity Burden. Ann Vasc Surg 2024; 100:155-164. [PMID: 37852366 DOI: 10.1016/j.avsg.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Operative risk for supra-aortic trunk (SAT) surgical revascularization for occlusive disease, particularly transthoracic reconstruction (TR), remains ill-defined. This study sought to describe and compare 30-day outcomes of TR and extra-anatomic (ER) SAT surgical reconstruction for an occlusive indication across the United States over a contemporary 15-year period. METHODS Using the National Surgical Quality Improvement Program, TR and ER performed during 2005-2019 were identified. Procedures performed for nonocclusive indications and those concomitant with coronary or valve operations were excluded. Rates of stroke, death, myocardial infarction (MI) and these as composite outcome (S/D/M) were compared. Logistic regression with stabilized inverse probability weighting (IPW) was used to compare groups via average treatment effect (ATE) while adjusting for covariate imbalances. RESULTS Over the 15-year period, 166 TR and 1,900 ER patients were identified. The majority of ERs were carotid-subclavian bypass (n = 1,344; 70.7%) followed by carotid-carotid bypass (n = 261; 13.7%) and subclavian/carotid transpositions (n = 123; 6.5%). TR consisted of aorto-SAT bypass (n = 120; 72.3%) and endarterectomy (n = 46; 27.7%). The median age was 64 years for TR and 65 years in ER (P = 0.039). Those undergoing TR were more often women (69.0% vs. 56.9%; P = 0.001) and less likely to have undergone previous cardiac surgery (9.2% vs. 20.8%; P = 0.006). TR were also less frequently hypertensive (68.1% vs. 75.4%; P = 0.038) and had statistically lower preoperative creatinine levels (0.86 vs 0.91; P = 0.002). Unadjusted rates of MI (0.6% vs. 1.3%; P = 0.72) and stroke (3.6% vs. 1.9%; P = 0.15) were similar between groups with mortality (3.6% vs. 1.5%; P = 0.05) and S/D/M (6.6% vs. 3.9%; P = 0.10) trending higher with TR. IPWs could be calculated for 1,754 patients (148 TR; 1,606 ER). The estimated probability of S/D/M was 3.8% in the ER group and 6.2% in TR; no difference was seen in ATE (2.4%; 95% confidence interval [CI]: -1.5 to 6.2; P = 0.23). No differences were seen in individual component ATEs (stroke: 3.0% vs. 1.7%; ATE = 1.3%; 95% CI: -3.9 to 1.3; P = 0.32; mortality: 3.8% vs. 1.4%; ATE = 2.4%; 95% CI: -5.6 to 0.7; P = 0.13). Secondary outcomes showed TR patients were more likely to have non-home discharge (18.7% vs. 6.6%; ATE = 12.1%; 95% CI: 5.0-19.2; P < 0.001) and longer lengths of stay (6.1 vs. 4.0; ATE = 2.2 days; 95% CI: 0.9-3.4; P < 0.001). Moreover, TR patients were more likely to require transfusion (22.7% vs. 5.0%; ATE = 17.7%; 95% CI: 10.2-25.2; P < 0.001) and develop sepsis (2.7% vs. 0.2%; ATE = 2.5%; 95% CI: 0.1-5.0; P = 0.04). CONCLUSIONS Transthoracic and extra-anatomic surgical reconstruction of the SATs for occlusive disease have similar operative cardiovascular risk. However, morbidity tends to be higher with TR due to higher transfusion requirements, sepsis risk, and need for facility stay. These results suggest ER as a first-line approach in those with proper disease anatomy is reasonable with lower morbidity, while TR remains justified in appropriate patients.
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Affiliation(s)
- Anthony V Norman
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Mark E Smolkin
- Division of Biostatistics, Department of Public Health Sciences, Old Med School, University of Virginia, Charlottesville, VA
| | - Behzad S Farivar
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Margaret C Tracci
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - M Libby Weaver
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - John A Kern
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, Old Med School, University of Virginia, Charlottesville, VA
| | - W Darrin Clouse
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA.
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Al-Sharydah AM, AlZahrani KS, Alghanimi IA, AlAnazi MM, AlHarbi RE. Anatomical Distribution Patterns of Peripheral Arterial Disease in the Upper Extremities According to Patient Characteristics: A Retrospective Cohort Study. Vasc Health Risk Manag 2023; 19:871-883. [PMID: 38173811 PMCID: PMC10762427 DOI: 10.2147/vhrm.s440408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Peripheral arterial disease (PAD) greatly affects the patients' quality of life. We aimed to investigate the affected anatomical sites and distribution patterns in upper extremity PAD using computed tomography angiography (CTA). Furthermore, we sought to identify the correlations between patient characteristics and the identified patterns. Patients and Methods This was a retrospective chart review of upper limb CTA findings from patients with symptomatic PAD aged >18 years. Significant variables from univariate logistic regression analysis were further tested using multivariate logistic regression analysis. Statistical significance was set at p < 0.05, with confidence intervals of 95%. Results The mean age of the 102 included patients with upper extremity PAD was 55.45 years. Laterality analysis revealed that the upper left limb segments were more affected than the upper right limb segments (42 vs 63; left-to-right ratio, 3:2). The forearm was the segment most affected by stenotic PAD (62 segments, 3.37%). The arm was the segment most affected by occlusive PAD (14 segments, 0.76%). Diabetes mellitus (DM) and hypertension (HTN) were significant predictors of PAD (p = 0.046). In patients with DM, the occlusive form of PAD was dominant in the arm (18.18%); however, the stenotic form prevailed in the forearm (72.72%). In patients with HTN, the occlusive form of PAD was predominant in the arm (45.45%); however, the stenotic form tended to occur in the arm and forearm (90.90%). Conclusion The distribution patterns of upper extremity PAD are linked to its underlying pathophysiology. HTN and DM are the most frequent comorbidities in patients with upper extremity PAD. Angiographically, PAD in these patients is likely to present as stenosis rather than as occlusion. This is vital for interventionists who deviate from radial arterial access in patients with PAD. Therefore, targeted screening standards are required, and further studies on PAD are warranted.
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Affiliation(s)
- Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar City, Eastern Province, Saudi Arabia
| | - Khaled Saud AlZahrani
- Radiology Department, King Fahad General Hospital-Jeddah, Ministry of Health, Al Andalus, Jeddah, 23325, Saudi Arabia
| | - Ibrahim Abobaker Alghanimi
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar City, Eastern Province, Saudi Arabia
| | - Maha Mukhlef AlAnazi
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar City, Eastern Province, Saudi Arabia
| | - Razan Essam AlHarbi
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar City, Eastern Province, Saudi Arabia
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Bordes SJ, Vefali B, Montorfano L, Bongiorno P, Grove M. Evaluation and Management of Complications of Endovascular Aneurysm Repair of the Thoracic Aorta. Cureus 2023; 15:e36930. [PMID: 37131556 PMCID: PMC10148752 DOI: 10.7759/cureus.36930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/04/2023] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) has become the standard of care for descending thoracic aortic pathology as the procedure has a historically low rate of reintervention and a high rate of success. However, TEVAR can be associated with complications such as endoleak, upper extremity limb ischemia, cerebrovascular ischemia, spinal cord ischemia, and post-implantation syndrome. An 80-year-old man with a history of complex thoracic aortic aneurysms underwent repair of a large thoracic aneurysm with a frozen elephant trunk procedure in 2019 at an outside institution. The proximal aortic graft extended to the arch and the innominate and left carotid artery were implanted into the distal portion of the graft. The endograft, extending from the proximal graft to the descending thoracic aorta, was fenestrated to maintain left subclavian artery flow. In an attempt to gain a seal at the fenestration, a Viabahn graft (Gore, Flagstaff, AZ, USA) was inserted. A type III endoleak was identified postoperatively at the fenestration, and a second Viabahn graft was required to gain a seal during the initial hospitalization. In 2020, an endoleak persisted at the fenestration on follow-up imaging, but the aneurysmal sac was stable. No intervention was recommended. The patient later presented to our institution with three days of chest pain. A type III endoleak at the level of the subclavian fenestration persisted with significant enlargement of the aneurysm sac. The patient underwent an urgent repair of the endoleak. This consisted of covering the fenestration with an endograft and left carotid to subclavian bypass. Subsequently, the patient developed a transient ischemic attack (TIA) due to kinking and extrinsic compression by the large aneurysm sac of the proximal left common carotid artery, requiring a right carotid to left carotid-axillary graft bypass. This report with a literature review discusses TEVAR complications and outlines methods to approach them. TEVAR complications and their management should be firmly understood to improve overall treatment outcomes.
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Affiliation(s)
- Stephen J Bordes
- Surgery, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Baris Vefali
- Cardiology, St. Michael Medical Center, Newark, USA
| | - Lisandro Montorfano
- Surgery, Vanderbilt University Medical Center, Nashville, USA
- Surgery, Cleveland Clinic Florida, Weston, USA
| | | | - Mark Grove
- Vascular Surgery, Cleveland Clinic Florida, Weston, USA
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4
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Beloyartsev DF, Adyrkhaev ZA, Fagamov RR. [Treatment of atherosclerotic lesion of the first segment of subclavian artery]. Khirurgiia (Mosk) 2023:95-102. [PMID: 38088846 DOI: 10.17116/hirurgia202312195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.
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Affiliation(s)
- D F Beloyartsev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Z A Adyrkhaev
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - R R Fagamov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Yamaguchi K, Funatsu T, Moteki Y, Nonaka T, Niwa A, Imanaka K, Kim K, Ishikawa T, Mochizuki T, Okada Y, Kawamata T. Subclavian Artery-Carotid Artery Bypass for Subclavian Artery or Common Carotid Artery Severe Stenosis or Occlusion. Neurol Med Chir (Tokyo) 2023. [PMID: 37005246 DOI: 10.2176/jns-nmc.2022-0307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Various surgical treatments are available for occlusive subclavian and common carotid artery diseases. Nevertheless, to date, when cerebral endovascular treatment is utilized, revascularization via direct surgery may be required. This study reported five symptomatic cases of revascularization for CCA and SCA occlusive and stenotic lesions that were expected to be challenging to treat with endovascular treatment. We performed subclavian artery-common carotid artery or internal carotid artery bypass using artificial blood vessels or saphenous vein grafts in five patients with subclavian steal syndrome, symptomatic common carotid artery occlusion, and severe proximal common carotid artery stenosis. In this study, good bypass patency was achieved in all five cases. Although there were no intraoperative complications, one patient had a postoperative lymphatic leak. Moreover, there was no recurrence of stroke during postoperative follow-up for an average of 2 years. Conclusively, subclavian artery-common carotid artery bypass can be an effective surgical treatment for common carotid artery occlusion, proximal common carotid artery stenosis, and subclavian artery occlusion.
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Affiliation(s)
- Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University
| | | | - Yosuke Moteki
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Taku Nonaka
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Akihiro Niwa
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Kosuke Imanaka
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Kilsoo Kim
- Department of Neurosurgery, Tokyo Women's Medical University
| | | | | | - Yoshikazu Okada
- Department of Neurosurgery, St. Luke's International Hospital
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Chaney M, Martinez-Zavala V, El Khoury R, Joshi G, Jacobs CE, White JV, Schwartz LB. Transposition of left subclavian artery with reimplantation of isolated left vertebral artery before thoracic endovascular aneurysm repair for type B aortic dissection. J Vasc Surg Cases Innov Tech 2022; 8:222-226. [PMID: 35493343 PMCID: PMC9046120 DOI: 10.1016/j.jvscit.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/04/2022] [Indexed: 11/28/2022] Open
Abstract
Understanding and recognizing anatomic anomalies of the aortic arch is important when planning extra-anatomic debranching before thoracic endovascular aortic repair. A rare anomaly is the left vertebral artery aberrantly arising from the aortic arch; found in ∼5% of adults. When present, the artery courses through the carotid sheath at a variable length before entering the third or fourth cervical transverse foramen. In the present report, we have described the case of a 49-year-old man with a symptomatic, enlarging type B aortic dissection with an aberrant left vertebral artery and the novel methods used to surgically correct his pathology.
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Affiliation(s)
- Michael Chaney
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
- Correspondence: Michael Chaney, BS, Department of Surgery, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068
| | | | - Rym El Khoury
- Division of Vascular Surgery, University of California, San Francisco, San Francisco, CA
| | - Gaurang Joshi
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Chad E. Jacobs
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - John V. White
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Lewis B. Schwartz
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
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Ahmed MA, Parwani D, Mahawar A, Gorantla VR. Subclavian Artery Calcification: A Narrative Review. Cureus 2022; 14:e23312. [PMID: 35464515 PMCID: PMC9015066 DOI: 10.7759/cureus.23312] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 01/02/2023] Open
Abstract
Subclavian artery calcification (SAC) affects 2% of the population and presents a serious risk of developing into subclavian steal syndrome (SSS). Risk factors for plaque formation of the subclavian artery include diabetes, hypertension, and smoking. While SAC generally presents as asymptomatic, symptoms in severe cases may include numbness, pain at rest, and ischemic gangrene. Patients with severe SSS are at high risk of developing neurological symptoms as a result of vertebrobasilar insufficiency affecting posterior cerebral perfusion. On physical examination, SSS is preliminarily diagnosed from bilateral inter-arm systolic blood pressure discrepancy (>10 mmHg), which can be further confirmed with vascular imaging. Duplex ultrasound (DUS) is a cost-effective and non-invasive baseline technique for visualizing luminal stenosis and quantifying peak systolic velocity (PSV). Computed tomography angiography (CTA) provides high-quality, fast, three-dimensional (3D) imaging at the cost of introducing nephrotoxic contrast agents. Magnetic resonance angiography (MRA) is the safest 3D imaging modality, without the use of X-rays and contrast agents, that is useful in assessing plaque characteristics and degree of stenosis. DUS-assisted digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis in the subclavian artery and determining the distance between the puncture site and lesion, which can be carried out in a combined procedure with endovascular management strategies. The fundamental treatment options are surgical and endovascular intervention. Endovascular treatment options include percutaneous transluminal angiography (PTA) for recanalization of the stenosed vessel and permanent balloon stenting to prevent collapse after PTA. Overall, the benefits of endovascular management encompass faster recovery, lower stenosis recurrence rate, and lower incidence of complications, making it the treatment of choice in low-risk patients. Surgical interventions, although more complex, are considered gold-standard treatment options.
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Physician-modified Endograft with Left Subclavian Artery Fenestration for Ruptured Type B Aortic Dissection. Ann Vasc Surg 2021; 77:352.e7-352.e11. [PMID: 34455042 DOI: 10.1016/j.avsg.2021.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022]
Abstract
A 56-year-old male patient was transferred to our institution with acute chest and back pain and deteriorating vital signs for 3 days. Emergent computed tomography angiography (CTA) revealed ruptured type B aortic dissection with large left hemothorax. The dissection extended into the left subclavian artery (LSA). Immediate endovascular aortic repair with LSA coverage to extend the proximal landing zone was planned. Fenestrated thoracic endovascular repair (fTEVAR) was performed using a physician-modified endograft (PMEG) to maintain LSA perfusion. The thoracic endograft was modified on a back table while anesthesia was given, and arterial accesses were acquired. FTEVAR was performed smoothly without any complication. Completion angiogram showed no evidence of endoleak or active bleeding. Chest tube was then placed, and the left lung gradually expanded. Postoperative hospital courses were uneventful. Follow-up CTA showed the thoracic endograft and the LSA stent were in good position, and the rupture thoracic aorta was completely sealed. Chest tube was removed on postoperative day (POD) 7. He was discharged home on POD 20 without any complications. Detailed techniques of PMEG for LSA fenestration are described.
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Laurin C, Chu MWA, Appoo JJ, Dagenais F. Transthoracic aorto-axillary extra-anatomical bypass for difficult subclavian artery revascularization: a multicenter patency study. Interact Cardiovasc Thorac Surg 2021; 33:763-764. [PMID: 34027547 DOI: 10.1093/icvts/ivab158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
In situ revascularization of the subclavian artery can be challenging in the context of emergency situations, a large aortic aneurysm with a posteriorly displaced left subclavian artery, a complex redo procedure or in the presence of an aberrant subclavian artery. A transthoracic aorto-axillary extra-anatomical bypass is a low risk alternative to in situ revascularization or carotid to subclavian bypass. We herein describe the surgical steps during a single-stage surgery complex aortic arch surgery. We report a 95.3% graft patency for 77 consecutive transthoracic aorto-axillary extra-anatomical bypass performed to 66 patients at the mean follow-up of 2.9 ± 2.4 years. We encountered 3 early (before 180 days postop) graft failures and no late graft failure. Graft failure had no clinical significance.
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Affiliation(s)
- Charles Laurin
- Cardiac Surgery Division, Quebec Heart and Lung Institute, Quebec, Canada
| | - Michael W A Chu
- Cardiac Surgery Division, Western University Hospital, London, Canada
| | - Jehangir J Appoo
- Cardiac Surgery Division, Libin Cardiovascular Institute, Calgary, Canada
| | - François Dagenais
- Cardiac Surgery Division, Quebec Heart and Lung Institute, Quebec, Canada
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10
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Lessons Learned after Iatrogenic Complete Transection of the Right Common Carotid Artery with Segmental Vessel Loss. Case Rep Vasc Med 2021; 2021:8812870. [PMID: 33854805 PMCID: PMC8019647 DOI: 10.1155/2021/8812870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/10/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
Carotid arterial injuries occur in 5-6% of persons with penetrating trauma. Complete transection is rare in civilian practice and is most often due to penetrating injuries. Complete transection as an iatrogenic complication is rare. We present a case where we were required to repair a complete transection of the carotid artery with segmental loss which occurred as an iatrogenic complication during thyroidectomy. We could find no previous reports of this type of iatrogenic complication. The lessons learned during the management of this case were the following: (1) surgeons should call for help early, (2) a multidisciplinary approach ensures that all options are considered, (3) adhere to surgical principles of proximal and distal control, (4) always use atraumatic clamps to control vessels, and (5) flow restoration should be attempted, leaving carotid ligation as the last resort.
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Upchurch GR, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, Murad MH, Perry RJ, Singh MJ, Veeraswamy RK, Wang GJ. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg 2021; 73:55S-83S. [DOI: 10.1016/j.jvs.2020.05.076] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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12
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Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2019; 39:763-816. [PMID: 28886620 DOI: 10.1093/eurheartj/ehx095] [Citation(s) in RCA: 1973] [Impact Index Per Article: 394.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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13
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Venermo M, Sprynger M, Desormais I, Björck M, Brodmann M, Cohnert T, De Carlo M, Espinola-Klein C, Kownator S, Mazzolai L, Naylor R, Vlachopoulos C, Ricco JB, Aboyans V. Editor's Choice – Follow-up of Patients After Revascularisation for Peripheral Arterial Diseases: A Consensus Document From the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 2019; 58:641-653. [DOI: 10.1016/j.ejvs.2019.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/08/2019] [Indexed: 10/25/2022]
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Venermo M, Sprynger M, Desormais I, Björck M, Brodmann M, Cohnert T, De Carlo M, Espinola-Klein C, Kownator S, Mazzolai L, Naylor R, Vlachopoulos C, Ricco JB, Aboyans V. Follow-up of patients after revascularisation for peripheral arterial diseases: a consensus document from the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery. Eur J Prev Cardiol 2019; 26:1971-1984. [DOI: 10.1177/2047487319846999] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often challenging. Early and late procedural complications, but also local and remote recurrences frequently lead to revascularisation failure. The rationale for surveillance is to propose the accurate implementation of preventive strategies to avoid other cardiovascular events and disease progression and avoid recurrence of symptoms and the need for redo revascularisation. Combined with vascular history and physical examination, duplex ultrasound scanning is the pivotal imaging technique for identifying revascularisation failures. Other non-invasive examinations (ankle and toe brachial index, computed tomography scan, magnetic resonance imaging) at regular intervals can optimise surveillance in specific settings. Currently, optimal revascularisation surveillance programmes are not well defined and systematic reviews addressing long-term results after revascularisation are lacking. We have systematically reviewed the literature addressing follow-up after revascularisation and we propose this consensus document as a complement to the recent guidelines for optimal surveillance of revascularised patients beyond the perioperative period.
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Affiliation(s)
- Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - Muriel Sprynger
- Department of Cardiology, University of Liege Hospital, Belgium
| | - Ileana Desormais
- Department of Thoracic and Vascular Surgery and Vascular Medicine, Dupuytren University Hospital, France
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University, Sweden
| | | | - Tina Cohnert
- Department of Vascular Surgery, Graz University Hospital, Austria
| | - Marco De Carlo
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Christine Espinola-Klein
- Center for Cardiology – Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | | | - Lucia Mazzolai
- Division of Angiology, Lausanne University Hospital, Switzerland
| | - Ross Naylor
- Department of Vascular Surgery, Leicester Vascular Institute, UK
| | | | | | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital and Inserm 1098, France
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Krishnappa S, Rachaiah JM, Hegde SS, Sadananda KS, Nanjappa MC, Ramasanjeevaiah G. Percutaneous Antegrade and Retrograde Endovascular approach to Symptomatic High-Grade Subclavian Artery Stenosis: Technique and Follow-Up. Heart Views 2019; 20:87-92. [PMID: 31620253 PMCID: PMC6791090 DOI: 10.4103/heartviews.heartviews_31_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: Angioplasty and stenting of the subclavian artery have been reported with high technical and clinical success rates, low complication rates, and good midterm patency rates. Different antegrade or retrograde endovascular catheter-based approaches are used. Nowadays, endovascular therapy has taken over open surgical techniques in subclavian artery disease. The purpose of this study was to determine safety, efficacy, and midterm clinical and radiological outcome of the endovascular treatment with special focus on the different technical approaches in subclavian artery disease. Materials and Methods: Between 2014 and 2017, 11 patients (10 men, 1 woman) with symptomatic high-grade stenosis (90%–100%) of the subclavian artery were treated with endovascular treatment. Their mean age was 51.3 years (range, 32-61 years). Mean angiographic and clinical follow-up was 22.5 months (range, 5-44 months). Clinical follow-up was performed at hospital discharge and routine follow-up was performed at 1, 3, 12 months, and 6 monthly thereafter. In all 11 patients, a percutaneous approach was used successfully. In eight patients, the lesions were accessed retrogradely through a brachial artery puncture. Results: Acute success rate was 100%. There were no significant peri-procedure complications. At the latest clinical follow-up (mean of 22.5 months), all patients showed a good outcome with a restenosis rate of 18.2% including a patient with Takayasu arteritis. Conclusion: Percutaneous antegrade and retrograde stenting of high-grade subclavian artery stenosis is a viable less invasive alternative to open bypass surgery with good midterm clinical results and patency rates.
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Affiliation(s)
- Santhosh Krishnappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | | | - Srinidhi S Hegde
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
| | | | | | - Govardhan Ramasanjeevaiah
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
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16
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Galyfos GC, Kakisis I, Maltezos C, Geroulakos G. Open versus endovascular treatment of subclavian artery atherosclerotic disease. J Vasc Surg 2019; 69:269-279.e7. [DOI: 10.1016/j.jvs.2018.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
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17
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Usai MV, Bosiers MJ, Bisdas T, Torsello G, Beropoulis E, Kasprzak B, Stachmann A, Stavroulakis K. Surgical versus endovascular revascularization of subclavian artery arteriosclerotic disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:53-59. [PMID: 29786405 DOI: 10.23736/s0021-9509.18.10144-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endovascular treatment offers an alternative, less invasive approach to open repair for subclavian artery atherosclerotic disease (SAAD). However, only few studies compared the outcomes of both strategies in the long run. This study reports on the performance of endovascular and surgical revascularization for SAAD. METHODS A retrospective review was conducted on patients treated for SAAD at two institutions between January 1998 and December 2015. Primary outcome of this study was the composite endpoint of reintervention-free survival (RFS) defined as time to reintervention and/or death from any cause. Secondary endpoints included primary patency (PPR) and secondary patency (SPR) rates as well as overall survival and time to reintervention. RESULTS Surgical treatment was the preferred treatment option in 27 (25%) patients, while 83 (75%) patients underwent primary stent therapy. The median follow-up was 87 months (interquartile range [IQR]: 38 to 151) in the surgical group and 27 (IQR: 12 to 59) in the endovascular (P=0.0001). Severe arterial wall calcification was more commonly observed in the surgical arm (P<0.0001), while mild and moderate calcification in the endovascular (P=0.0004 and P=0.014). Vessel occlusion was more frequent among patients treated surgically (100% vs. 34%, P<0.0001). At 98 months RFS was significantly higher after surgical treatment (95% vs. 54%, HR: 8.4, 95% CI: 3.9 to 18.1, P=0.0002). Although overall survival did not differ significantly between the two groups (HR: 4.28, 95% CI: 0.86 to 21.22, P=0.093), open repair was associated with reduced reintervention rate (HR: 12.04, 95% CI: 4.98 to 29.12, P=0.001). The PPR at 98 months following surgical and endovascular therapy amounted to 96% and 65% (HR: 12.87, 95% CI: 5.44 to 30.44, P=0.0008) respectively. No significant difference was observed regarding the SPR between the two groups (100% vs. 95%, P=0.090). CONCLUSIONS Surgical treatment was associated in this cohort with increased patency and a significant reduction of reinterventions compared to the endovascular approach.
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Affiliation(s)
- Marco V Usai
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany - .,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany -
| | - Michel J Bosiers
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Efthymis Beropoulis
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Bernd Kasprzak
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Arne Stachmann
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany.,Department of Vascular Surgery and Endovascular Surgery, University Clinic of Münster, Münster, Germany
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18
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Extra-Thoracic Supra-aortic Bypass Surgery Is Safe in Thoracic Endovascular Aortic Repair and Arterial Occlusive Disease Treatment. Eur J Vasc Endovasc Surg 2018; 55:861-866. [PMID: 29685679 DOI: 10.1016/j.ejvs.2018.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 03/17/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The safety and feasibility of supra-aortic debranching as part of endovascular aortic surgery or as a treatment option for arterial occlusive disease (AOD) remains controversial. The aim of this study was to assess the clinical outcome of this surgery. METHODS This single centre, retrospective study included 107 patients (mean age 69.2 years, 38.4% women) who underwent supra-aortic bypass surgery (carotid-subclavian bypass, carotid-carotid bypass, and carotid-carotid-subclavian bypass) because of thoracic or thoraco-abdominal endovascular aortic repair (57%; 61/107) or as AOD treatment (42.9%; 46/107) between January 2006 and January 2015. Mortality, morbidity with a focus on neurological complications, and patency rate were assessed. Twenty-six of 107 (14.2%) of the debranching patients were treated under emergency conditions because of acute type B dissection or symptomatic aneurysm. Follow up, conducted by imaging interpretation and telephone interviews, continued till March 2017 (mean 42.1, 0-125, months). RESULTS The in hospital mortality rate was 10.2% (11/107), all of these cases from the debranching group and related to emergency procedures (p < .0001). One procedure related death of a patient in the debranching group, who had a lethal stroke 72 months post-operatively following bypass occlusion was observed. Early neurological complications were recognised in 10 patients, including two transient cases of Horner syndrome and vocal cord paralysis as well as six cases of phrenic nerve apraxia. Three cases of stenosis and one case of occlusion were successfully treated. In three AOD patients, the graft had to be exchanged because of peri-graft reaction. Primary and secondary patency rates of 96 patients after 36 months were 95% (SE 2.6%) and 98% (SE 1.8%), respectively. CONCLUSIONS Extra-thoracic supra-aortic bypass surgery involves low complication rates and high mid-term bypass patency rates. It is a safe and feasible treatment option in the form of debranching in combination with endovascular aortic aneurysm repair and in AOD.
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Wooster M, Back M, Sutzko D, Gaeto H, Armstrong P, Shames M. A 10-Year Experience Using a Hybrid Endovascular Approach to Treat Aberrant Subclavian Arterial Aneurysms. Ann Vasc Surg 2018; 46:60-64. [DOI: 10.1016/j.avsg.2017.03.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/04/2017] [Accepted: 03/17/2017] [Indexed: 11/17/2022]
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20
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Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 55:305-368. [PMID: 28851596 DOI: 10.1016/j.ejvs.2017.07.018] [Citation(s) in RCA: 662] [Impact Index Per Article: 94.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Epperla N, Ye F, Idris A, Sakkalaek A, Liang H, Chyou PH, Dart RA, Mazza J, Yale S. Treatment-Related Cardiovascular Outcomes in Patients with Symptomatic Subclavian Artery Stenosis. Cureus 2017; 9:e1262. [PMID: 28652946 PMCID: PMC5476475 DOI: 10.7759/cureus.1262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Subclavian artery stenosis (SAS) is narrowing of the subclavian artery most commonly caused by atherosclerosis. It serves as a marker for cerebrovascular and myocardial ischemic events. Methods A retrospective cohort study was conducted to determine the association of treatment via combination therapy (antiplatelet drug plus either by-pass surgery or percutaneous transluminal angioplasty (PTA) with or without stent implantation) versus antiplatelet drug therapy alone on cardiovascular events and all-cause mortality in Marshfield Clinic patients diagnosed with symptomatic SAS from January 1, 1995 to December 31, 2009. Results Of the total 2153 cases, 100 patients were identified as eligible to be included in the study. Of these 100 patients that met inclusion criteria, 30 underwent combination therapy while 70 were managed only with drug treatment. A median length of follow-up was 8.45 years. Adverse cardiovascular events occurred in 5/30 (17%) of combination therapy patients compared to 28/70 (40%) of antiplatelet drug therapy only patients (p = 0.0355). Accordingly, all-cause mortality was higher (47%) in the antiplatelet drug therapy only group than the combination therapy group (13%) [hazard ratio = 3.45, p = 0.0218]. Conclusions Preliminary findings in this pilot data set suggest that combination therapy (medications plus either surgical or interventional repair) of subclavian artery stenosis is associated with less cardiovascular adverse events and higher survival rates. However, prospective randomized studies with larger number of patients are needed to validate these findings.
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Affiliation(s)
| | - Fan Ye
- GME Internal Medicine Residency Program, North Florida Regional Medical Center
| | - Amr Idris
- GME Internal Medicine Residency Program, North Florida Regional Medical Center
| | - Adeeb Sakkalaek
- GME Internal Medicine Residency Program, North Florida Regional Medical Center
| | - Hong Liang
- GME Internal Medicine Residency Program, North Florida Regional Medical Center
| | - Po-Huang Chyou
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation
| | - Richard A Dart
- Center for Human Genetics, Marshfield Clinic Research Foundation
| | - Joseph Mazza
- Department of Clinical Research, Marshfield Clinic Research Foundation
| | - Steven Yale
- Internal Medicine, University of Central Florida College of Medicine
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Lazovski N, Jovev S, Babic D, Babic S, Dzemali O. Transposition of Subclavian Artery - Is It the Appropriate Choice? Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2017; 38:47-51. [PMID: 28593884 DOI: 10.1515/prilozi-2017-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To present patients with symptomatic subclavian artery disease and treatment possibility. CASE REPORT A 53-year-old female was admitted with vertigo and left arm claudication. Duplex-scan and MSCT arteriography verified subclavian artery occlusion. After the endovascular treatment failure, the patient was switched to surgical treatment - subclavian artery transposition. After the successful surgical treatment, the patient was discharged on the second postoperative day. If the patient is a candidate for surgery, the literature review shows good initial and long-term results after the subclavian artery transposition, and emphasizes this technique as superior. CONCLUSION Subclavian carotid transposition is a safe and effective method of treatment in patients after endovascular treatment failure or other indication. Also, the surgical treatment is technically demanding because of the difficult access to the vessel origin, and it requires experienced surgeons.
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Affiliation(s)
| | - Sasko Jovev
- University Clinic for Cardiac Surgery, Skopje
| | - Dusan Babic
- Institute for Cardiovascular diseases, Dedinje, Belgrade
| | - Srdjan Babic
- Institute for Cardiovascular diseases, Dedinje, Belgrade
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Coronary-subclavian steal syndrome following CABG: A case report and literature review. Res Cardiovasc Med 2017. [DOI: 10.5812/cardiovascmed.34079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Salman R, Hornsby J, Wright LJ, Elsaid T, Timmons G, Mudawi A, Bhattacharya V. Treatment of subclavian artery stenosis: A case series. Int J Surg Case Rep 2015; 19:69-74. [PMID: 26722712 PMCID: PMC4756098 DOI: 10.1016/j.ijscr.2015.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
Case presentation of a patient treated with subclavian artery stenting. Case presentation of a patient treated with transposition of the left subclavian artery onto the left common carotid artery. Case presentation of a patient treated with carotid- subclavian artery bypass with a PTFE graft. Case presentation of a patient treated with carotid to axillary bypass. Discussion and literature review of methods and indications of treatment of subclavian artery occlusive disease.
Introduction In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options. Presentation Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass. Discussion and conclusion This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities.
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Affiliation(s)
- Reem Salman
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Jane Hornsby
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Lucie J Wright
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Tarek Elsaid
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Grace Timmons
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Ahmed Mudawi
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
| | - Vish Bhattacharya
- Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead NE9 6SX, UK.
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Hinojosa CA, Anaya-Ayala JE, Laparra-Escareno H, Guerrero-Hernandez M, Galindo-Uribe J. Eversion Subclavian Endarterectomy and Transposition for Coronary-Subclavian Steal Syndrome in a Patient with Refractory Angina Pectoris. Ann Vasc Surg 2015; 30:305.e11-4. [PMID: 26522585 DOI: 10.1016/j.avsg.2015.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/16/2022]
Abstract
Late onset of angina pectoris associated with subclavian artery (SA) atherosclerotic occlusive disease is a rare and recognized cause of myocardial ischemia when the lesion is proximal to a left internal mammary artery (LIMA) to coronary bypass. The symptoms typically exacerbate by increasing the flow demand in the extremity; this phenomenon is known as late coronary-subclavian steal syndrome. We describe the case of a 66-year-old woman who underwent coronary artery bypass grafting from the LIMA to the left anterior descending coronary artery in 2000. Years later, she experienced refractory angina pectoris associated to an occlusive lesion in the proximal left SA. SA endarterectomy with eversion technique and subclavian-carotid transposition restored the antegrade flow with resolution of the symptomatology.
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Affiliation(s)
- Carlos A Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
| | - Javier E Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Hugo Laparra-Escareno
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Manuel Guerrero-Hernandez
- Department of Interventional Radiology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Jaime Galindo-Uribe
- Department of Cardiology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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